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Background: Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes. Objectives: Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy. Method: Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT–Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment. Results: A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT–Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13–1.38; P = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms. Conclusion: This study demonstrated that an adherence game intervention could help keep PLWH in care. What this study adds: Evidence that interventions, especially Games, could improve retention in care.

No abstract available.

Obtaining consent for HIV research is complex, particularly in low- and middle-income countries. Low levels of education, complexity of science and research processes, confusion about basic elements of research, and socio-economic conditions that make access to medical care difficult have collectively led to concerns about the adequacy of the consent process. Given the exponential growth of HIV prevention and treatment research in South Africa, HIV researchers are increasingly facing challenges obtaining authentic informed consent from potential participants. It is anticipated that HIV cure research, despite being in its infancy in South Africa, will introduce a new discourse into a population that is often struggling to understand the differences between ‘cure’, ‘preventive and therapeutic vaccines’ and other elements of the research process. Coupled with this, South Africa has a complex history of ‘illegitimate’ or ‘false cures’ for HIV. It is therefore logical to anticipate that HIV cure research may face significant challenges during consent processes.HIV prevention research in South Africa has demonstrated the importance of early community engagement in educating potential research participants and promoting community acceptance of research. Consequently, in an attempt to extrapolate from this experience of engaging with communities early regarding cure research, a 15-minute educational video entitled ‘I have a dream: a world without HIV’ was developed to educate and ultimately empower potential research participants to make informed choices during consent processes in future HIV cure clinical trials. To aid others in the development of educational interventions, this paper discusses the challenges faced in developing this educational video.

No abstract available.

Background: This research focused on patients’ views regarding healthcare services and identified factors associated with understanding of their management plan. Aim: To develop a baseline for patient–clinician collaboration and the extent to which patients felt included and understood their treatment plan. Setting: Tshwane district (South Africa) public health outpatient clinics. Method: Medical students interviewed 447 patients in 22 clinics in Tshwane district. Agreement was measured by the percentage of cases in which patients and clinicians were in accord about a particular aspect of the consultation. Results: About one-third of patients incorrectly answered questions on whether changes in lifestyle or diet were prescribed as part of their treatment. The likelihood that patients understood their plan was associated with seeing the same clinician three or more times;having a consultation in their same or a similar language; patient participation in the diagnosis;and feeling that the clinician had explained their health problems to them. Conclusions: There is need for greater emphasis on continuity of care, the clinicians’ ability to speak the patient’s language and involving patients in the consultation.